Rebellion21: SAVE the EYE – Lateral Canthotomy via Andy Little, DO

Of the Many High Acuity Low Occurrence (HALO) procedures in medicine, few are as daunting as performing a lateral canthotomy. For EM providers it is key to understand the indications, anatomy, and steps to performing this procedure on the right patients, their sight may depend on it. In this 12-minute presentation from Rebellion in EM 2021, Dr. Andy Little, DO walks us through the steps of performing a lateral canthotomy.

Andy Little, DO
Emergency Medicine
Associate Program Director
AdventHealth Orlando EM Residency Program
Orlando, FL
Twitter: @andyglittle


  1. Discuss the indications for performing a lateral canthotomy
  2. Discuss the anatomy of the eye crucial to performing a lateral canthotomy


  1. Discuss the Indications for a Lateral Canthotomy
    1. Retrobulbar Bleed
    2. Decreased Visual Acuity
    3. Acute presentation of an Afferent Pupillary Defect
    4. Notable/New Proptosis
    5. Increased Intra-ocular Pressure
      1. > 40 mmHg
  2. Discuss the Complications/Contra-indications** of performing a lateral canthotomy
    1. Incomplete cantholysis
    2. Iatrogenic globe
    3. Surrounding structure injury (rare)
    4. Loss of adequate lower lid suspension
    5. Bleeding
    6. Infection
    7. Globe Rupture**
  3. Discuss the anatomy of the eye in relation to performing a lateral canthotomy

4. Discuss the materials needed to perform a lateral canthotomy

    • Betadine prep
    • Sterile drape or towels
    • Lidocaine with epi
    • Syringe with 27-30ga needle
    • Normal saline for irrigation
    • Straight hemostat or needle driver
    • Iris or suture scissors
    • Forceps

5. Provide step by step instructions to performing a lateral canthotomy


  1. Rowh AD et al. Lateral Canthotomy and Cantholysis: Emergency Management of Orbital Compartment Syndrome. JEM 2015. PMID: 25524455
  2. Murali S. Orbital Compartment Syndrome – Pearls and Pitfalls for the ED Physician. REBEL EM Blog 2020. [Link is HERE]

Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter: @srrezaie)

Cite this article as: Salim Rezaie, "Rebellion21: SAVE the EYE – Lateral Canthotomy via Andy Little, DO", REBEL EM blog, October 9, 2021. Available at:

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